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Insurance - Mike Kilbride 2017-11-06AC"Ro CERTIFICATE OF LIABILITY INSURANCE DATE (MM DDINY, 1110612017 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policylles) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsement(s). PRWJCER PI (760)8373626 Far. (780)8373898 CONTACT M. L. Adams Insurance Services M. L. ADAMS INSURANCE SERVICES "AME-- - _ _ --- -- 42-280 BEACON HILL, SUITE D-7 racNN,. EA) (760) 837-3626 ac �; (760) 837-3898 EW PALM DESERT CA 922115 S 168 ADDR www.mladamsins.eom AIL _ IN8URERIS) AFFORDING COVERAGE NAIC# Agency Uc$t OSD 232 INSURER A Colony IRSUFance Co MIKE KILBRIDE, LTD. INSURER 9 State Compensation Insurance Fund 35076 MIKE COAST WATER AND POWER INSURER Colony Insurance Co P.O. BOX 3341 INSURER c NEWPORT BEACH CA 92659 INSURER E INSURER F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISI ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, LTR __,_- TYPE OF INSURANCEeISD ZE POLICY NUMBER ' LIMITS A X COMMERcrl1LGENERAL LMBaRY Y X X 103GLOO15876-01 _LMMNNYY)__IMMIODRYYYI 10/30117 10130118 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE OCCUR 'onA A ETORENTED S 100,000 _ PREMISES(Es aaa 1 - MED.EXP(Anyonep.) E 5,000 - PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER '.. GENERAL AGGREGATE $ 2,000,000 POLICY X Eo- _ LOC ''. PRODUCTS COMP/OP AGG S 2,006,600 OTHER E AUTOMOBILE LIABILITY CDMBL^IEET]EINGLE tIMrt (Ea accaaa) E ANY AUTO _—_— BODILY INJURY (Per Peron) b ALL O SCHEDULED __ AUTOS BODILY INJURY (Par accklen0 E _- -AUTOS HIRED AUTOS NON -OWNED PAppERry DAMAGE E AUTOS AUTOS ' (paramlaen0 S C UMBR USE X OCCUR XS172707 10/30/17 10130118 EACH OCCURRENCE E 2,000,000 EXCESS Lw OLAIMSlMAOE AGGREGATE S 2,000,000 DED RETENTIONE g B MRXERS w EENWTmx - X 9067110-17 10/0117 10101118 X 1,000,000 AND EMPLOYERS' LM&LRY STATUrEE ER ART PROPRIUMPARTNERIE)CECUTIVE YIN E.L. EACH ACCIDENT $ 1,000,000 OFRCERR.tEMSER EXCLUDED? N,A IManrMteryin ION)-- - I, E.L. DISEASE -Eq EMPLOYEE E INCLUDED I'M Osscrw. Mpr DEscarRTroN or OPERAnorvs aew,a ' '. E.L. DISEASE POLICY LIMIT $ INCLUDED I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 161• AtltllUonal Remarks Schedule, mey be attached 1t mare space is regnireN) RE: ALL OPERATIONS THE COSTA MESA SANITARY DISTRICT, IT'S ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSUREDS PERFORM CG 2012 0413 ATTACHED. PRIMARY WORDING PERFORM CG 20 010413 ATTACHED. 30 DAYS NOTICE OF CANCELLATION PER FORM ATTACHED. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COSTA MESA SANITARY DISTRICT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 PAULARINO AVENUE an ACCORDANCE WITH THE POLICY PROVISIONS. COSTA MESA, CA 92626 `C7� V I al� Y AIJT ORIZED REPRLSENTATIVE - - ,Jq [/,/,•�j^ , Attention: Michael L. (Mike) Adams I ne A1.VMU name ana logo are reglsterea mafHS OT ALUKU POLICY NUMBER: 103 GL 0015876-01 103 GL 0015876.01 COMMERCIAL GENERAL LIABILITY CG 20 12 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. This insurance does not apply to: include as an additional insured any state or a. "Bodily injury", "property damage" or governmental agency or subdivision or political "personal and advertising injury" arising out subdivision shown in the Schedule, subject to the of operations performed for the federal following provisions: government, state or municipality; or 1. This insurance applies only with respect to b. "Bodily'u injury" or "property damage" operations performed by you or on your behalf included within the "products -completed for which the state or governmental agency or operations hazard". subdivision or political subdivision has issued a permit or authorization. B. With respect to the insurance afforded to these additional insureds, the following is added to However: Section III — Limits Of Insurance: a. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent permitted required by a contract or agreement, the most we by law; and b. If coverage provided to the additional will pay on behalf of the additional insured is the insured is required by a contract or amount of insurance: agreement, the insurance afforded to such 1. Required by the contract or agreement; or additional insured will not be broader than 2. Available under the applicable Limits of that which you are required by the contract Insurance shown in the Declarations; or agreement to provide for such additional whichever is less. insured. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 103 GL 0015876.01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - DESIGNATED PERSON(S) OR ORGANIZATION(S) This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART SCHEDULE Name of Person(s) or Organization(s): The Person(s) or Organization(s) listed or described in the SCHEDULE above have requested that they receive written notice of cancellation when this policy is cancelled by us. It is agreed that should this policy be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice (10 days for non-payment of premium) to the additional insured. The notification of cancellation of the policy is solely for the purpose of informing the Person(s) or Organization(s) shown in the SCHEDULE the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. Our failure to provide such notification will not extend any policy cancellation date nor impact or negate any cancellation of the policy. Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to that statute or rule. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U900-0716 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that. (1) The additional insured is a Named Insured under such other insurance: and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 0104 13 © Insurance Services Office, Inc., 2012 Page 1 of 1